Why Has My Work Comp PTSD Claim Been Denied?

Since October 1, 2013, workers who have developed PTSD, or post-traumatic stress disorder, as a result of exposure to traumatic events while in the course and scope of their employment are entitled to workers’ compensation benefits in the state of Minnesota. Many of our clients with PTSD are police officers, State Troopers, corrections officers, deputy sheriffs, 911 dispatchers, and firefighters.

Despite that an employee may have been diagnosed with post-traumatic stress disorder by a licensed psychiatrist or psychologist and the treating physician determined that the employee developed PTSD as a result of traumatic work-related exposure or exposures, most work comp insurance companies will deny PTSD claims.

If a work comp insurance company denies your PTSD claim you should immediately consult with an attorney to bring a claim petition on your behalf.

Top Reasons Work Comp Insurance Companies Deny PTSD Claims

1.  The date of the injury is before October 1, 2013

Many adjusters are not familiar with the new law and the correct application of the law. If a police officer, firefighter, corrections officer, or 911 dispatcher witnessed or experienced a specific traumatic event before October 1, 2013, insurance companies typically deny primary liability of the claim. Even if the traumatic event did take place before October 1, 2013, the applicable date of injury used to determine compensable claims is the date the employee became disabled as a result of the condition.

2.  Inadequate medical support

While the employee’s doctor may find that the work activities caused the employee to develop PTSD, the work comp insurance carrier may find that they do not agree with the treating physician. At some point they may send you to an Independent Medical Exam or “IME” these exams are certainly not independent as the doctors are paid by the work comp insurer and likely will find that the employee does not have PTSD nor has he or she developed PTSD as a result of work-related exposures.

3.  The type of traumatic event was one that the employee was expected to be exposed as a part of regular job duties

This reason for denial has no basis in law nor does it make any sense. But, I’ve seen work comp adjusters use this reason as a basis for denial of primary liability. It’s irrelevant that as a part of the employee’s job duties he or she was exposed to horrifying, shocking, or disturbing events or that as a part of his or her job duties, it’s not unconceivable that he or she might be attacked or fear for his or her life.

4.  Non-compensable mental injury without physical injury

Despite that the law change as of October 1, 2013, and work comp in Minnesota no longer requires that the employee also experience an accompanying physical injury, many adjusters still deny on this basis.

5.  The employee did not physically witness the disturbing event

Under the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the qualifying diagnosis for PTSD has changed and allows for individuals who experience the disturbing events, although physically removed from the situation, to be diagnosed with PTSD. The DSM-V is the standard that doctors use to diagnose conditions. Therefore under the DSM-V, a 911 dispatcher may still be entitled to workers’ compensation benefits if he or she develops PTSD. But, adjusters will still deny claims for this reason.

If the work comp insurance company has denied your PTSD claim, their denial does not mean that you are not entitled wage loss benefits, rehabilitation, retraining, or medical benefits under the Minnesota Workers’ Compensation Act as a result of your disability.

At Meuser Law Office, P.A. we have successfully obtained benefits on behalf of employees who have developed post-traumatic stress Disorder both before and after the law changed on October 1, 2013. Our attorneys have represented many police officers, firefighters, corrections officers, and State Troopers with PTSD and successfully recovered benefits on their behalf. If you have developed PTSD as a result of your job duties contact our office today for a free, no-obligation consultation.

by Mary Beth
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